Direct access isn’t a program – it’s market design
Welcome to the direct access marketplace, where incentives are aligned by design so access becomes the default outcome.
By: Prescryptive Health
For years, the prescription drug debate has been framed as a tradeoff. Affordability versus innovation. Lower prices must come at someone’s expense. Transparency requires more oversight.
Paired with the ongoing struggle of rising prescription drug costs and nonadherence and its downstream impacts, it becomes clear: the value of every drug innovated lives and dies by access. If the patient doesn’t get on therapy, nothing else matters.
Yet today’s prescription drug market was not designed with access as its primary outcome. Better access is seen as requiring more management. That framing is wrong.
The real issue is market design
Today’s prescription drug market works exactly as it was built to work. Pharmacy benefit managers (PBMs) capture value through rebates, formulary control, and pharmacy steerage. Service models have emerged to help employers and manufacturers navigate that complexity. But those services sit on top of a system whose incentives remain fundamentally misaligned.
The result is predictable: distorted prices, restricted choice, and patients who struggle to access the medications they need.
Direct-to-consumer models, employer direct contracts, and pharmacy-as-care hubs are not isolated experiments. They reflect a broader shift in expectations: Access has now become the standard by which this system will be judged.
Patients want to afford their medication and choose the right product at the right pharmacy. Employers want value that shows up in outcomes, not rebate reports. Manufacturers want innovation to reach patients without distortion.
Direct access is now demanded. But direct access is not a program. It is not a service layer. And it is not a better way to manage a broken system.
Direct access is market design
In a true direct access marketplace, access is the default outcome — not something administered through prior authorizations, rebate negotiations, or utilization controls. Price, product, and pharmacy choice are unified and delivered directly to patients at the moment of prescribing, without intermediated control or incentive distortion.
A functioning direct access marketplace must:
- Connect all market participants
- Enable direct price and payment settlement
- Provide real price and product choice at the point of care
- Protect the patient-provider relationship
- Operate on neutral payment rails
- Prevent intermediary control and incentive distortion
When those elements exist together, incentives align by design. Access doesn’t have to be negotiated — it emerges naturally. If access needs to be managed, it isn’t direct.
This is why infrastructure matters
At Prescryptive, we built the Prescryptive Direct platform to enable and sustain the direct access marketplace. The platform reconnects product and price with value, unifying affordability, product choice, and pharmacy choice. It ensures that real transaction prices flow directly among manufacturers, payers, pharmacies, and patients — without rebate or spread economics.
Making the direct access marketplace durable through technology
Access cannot depend on a negotiation cycle or a temporary contract. It must be sustained across the prescription lifecycle. That durability happens when incentives are aligned at the foundation.
The prescription market does not need more programs layered on complexity. It needs a marketplace that works.
Direct access is the new standard. The direct access marketplace is how it’s delivered. And aligned, neutral infrastructure is what ensures that access becomes the consistent and natural outcome of a functioning marketplace.
Prescryptive was built for this moment. Ready to rewrite the script with us? Reach out.